McKesson Pharmacy Systems (MPS) President Stanton McComb sat down with ComputerTalk senior editor Will Lockwood at the McKesson Pharmacy Strategies Conference and Trade Show in Boston in July to talk about recent changes at MPS resulting from the Per-Se Technologies acquisition, the newest technology that MPS is offering, and the changes he sees ahead for retail pharmacy practice.

Stanton McComb: Two of the most exciting changes to come out of the recent merger between Per-Se Pharmacy Systems and McKesson Pharmacy Systems are our expanded customer base and staff.

The acquisition provides McKesson Pharmacy Systems with a far larger customer base, which gives us access to more relationships, more innovative ideas, and a greater understanding of what needs to be done to improve retail pharmacy from a technology perspective. Now, as we integrate our operations, we are especially focused on taking advantage of these new relationships. Our top-of-mind goal is to become exceptionally good at listening and responding to our customers, and communicating with them on a regular basis.

The second major change brought on by the acquisition is the makeup of our company. We now find ourselves with one of the greatest and largest pharmacy software teams in the country. This is a team that has a tremendous amount of experience. There are literally hundreds of MPS employees who have been working on pharmacy software for 15 or 20 years, and some even longer than that. Now that we have so many more resources at our disposal and so much more kNowledge inside of MPS, it’s exciting to think about how we can leverage that talent and bring it to bear on new opportunities for our customers.

CT: What do you see as the future of the pharmacy management system at McKesson? How does the Internet-enabled ASP [application service provider] model fit in?

McComb: I’ve been posed this question a few times already this week at our McKesson Pharmacy Strategies Conference and Trade Show. Everyone’s curious to know: Is the ASP delivery model here to stay? And is it working? I do believe that the ASP model is the way of the future — I really do. To be clear, when we say ASP, we are talking about a software delivery method that allows customers on-demand access over the Internet to their software application or solution, which is hosted at a remote site. There are a lot of benefits associated with this ASP delivery model. For example, it’s less expensive because it requires less hardware inside each store. If the application includes workflow and load balancing, a hosted system enables different stores to help each other out during the course of business because they can be given rights to work off of each other’s systems remotely. An ASP-enabled system also inherently allows you to centralize data, which helps simplify reporting and backup processes greatly. Keeping your system up to date with the latest versions of the software is also much easier –– as all new versions of an application can be loaded one time to one central server. And, Will, these are only a few of the benefits. So, yes, I am very excited about this technology in terms of what it means for our customers and the industry.

CT: What about ASP availability and reliability?

McComb: Those have been the historical trade-offs and the source of a lot of questions. However, we see problems with availability and reliability fading away now. McKesson has looked closely at the availability of high-speed connectivity, and we have found that there are very few locations in the United States that still cannot get access to high-speed Internet. So, as access becomes less and less of an issue, costs will continue to come down as well.

Plus, as our first-hand experience with the reliability of Internet-enabled applications like EnterpriseRx has demonstrated, we are up and running 99.9% of the time. That’s a service level that exceeds most banking ATM service levels, and we monitor uptime very closely. On top of that, McKesson has developed a special solution — called Down Time — that allows a pharmacy using EnterpriseRx to continue processing scripts if, for some reason, the store loses connectivity or the system does go down. Add to that solution McKesson’s extensive, world-class, and fully redundant IT infrastructure, and you have a very trustworthy solution. So, in truth, we do not see reliability being an issue for our customers.

CT: You mentioned workload balancing and centralized reporting a moment ago. Tell us more about what’s new here.

McComb: Sure. When we think about pharmacy operations today, there’s no question that workloads, for most, are increasing exponentially and reimbursement for everyone is steadily decreasing. Quite simply, this means that pharmacists and their staffs have to do more with fewer resources. Then you have to layer on top of this dynamic the fact that most store managers and owners struggle to find the time to run reports, review pricing, conduct special patient and prescriber marketing programs, and train staff. It makes life pretty tough, and makes for very long days.

Technology can make a significant difference in this area. First of all, the technology must be reliable, yet easy and efficient to use. At MPS, we think our newest pharmacy system, EnterpriseRx, can even be “fun” to use. Beyond that, we believe technology can empower and position our customers to optimize their business by automating more tasks that are either left undone today or that get done in a variable fashion. We also see next-generation pharmacy systems allowing staff to find time to do the things they want and need to do, such as spending time with customers and balancing work across stores and resources.

A centralized system can also enable independents and groups of independents to come together, cooperate, and potentially operate more like chains. In the future, we envision a program whereby we can create options for owners who say, “I want to share this data” but, “I don’t want to share that data” with other stores in my group or area. For example, I was just talking with somebody about pseudoephedrine who said, “We should be able to track psuedoephedrine dispensing and purchases across our local community and region.” This makes good sense, and we are launching just such a service this month. But it can be hard to do things like this when all your data is squirreled away in a store account on a store server. There are a lot of things like this that I think the ASP is a good solution for.

CT: Let’s talk about the new Pharmacy Navigator workflow system. What’s the history?

McComb: Eighteen months ago we sat down for an intense week-long brainstorming session with some customers and talked about all the things that drive them crazy and needlessly chew up their time. We talked about all the tasks that are tedious and don’t make good business sense. We talked about rework, the store dynamics around prior auth, partial fills, post-it notes, ever-changing staff schedules, and matching up different resources against variable levels of demand. We mapped it all out and started dreaming up solutions. It was really a great experience to think about how we wanted to solve the issues that were causing our customers the most pain and that were affecting their customer service and their employee satisfaction. We came up with 500 ideas and narrowed these down to 200. Then we said, “Let’s take these new ideas and enhance and rewrite workflow.” Pharmacy Navigator came out of that work.

CT: What can pharmacists expect from all the work that MPS did?

McComb: I’m really proud of what we have in Pharmacy Navigator. I believe it will help pharmacies smoothly match supply and demand. What I mean by that is this: Work comes in to the pharmacy on a variable basis and varies by day. However, at the end of every day, you need to deliver on the script when the patient demands it, and it’s going to be different from one patient to another, and one script to another, regardless of the ebb and flow of work in the pharmacy. Basic “Operations 101” is matching your resources with your demand to make sure that you hit particular service levels and that you are measuring your activities, which is exactly where Pharmacy Navigator fits in. We accentuated delivery-time-driven queues, which is not a new idea but does allow you to have the right information at the right time. We also added a dashboard that gives owners and managers a fresh look at what’s going on in the store. With the dashboard, you can see how productive individual staff members are and how profitable their work is. Today most pharmacies have no real idea what productivity levels are and what service levels are. Most people will claim that they fill scripts within 12 or 15 minutes, but, in reality, they do not measure that 24/7. If they want to improve service to their customers and find more time to offer new services, they need to truly understand their real performance results.

CT: This sounds as if you are moving workflow beyond the basic concept of dividing tasks in the filling process along a production line, and heading toward using it as a source for collecting and analyzing data as well. Is this right?

McComb: Exactly. Pharmacy Navigator is first and foremost about establishing organized operations, but it’s also now about optimization and continuously improving that workflow. For example, if you are monitoring your workflow you might find out that you have a bottleneck at your verification stage. Why is that? Maybe it’s because your pharmacist is spending too much time filling versus verifying. Or maybe you’ll find that you have a ton of inventory at will-call that’s not getting picked up. So perhaps to alleviate this, you could do more customer notifications. The next generation of workflow gives you this kind of detail. It’s more than just an image of a script and a pill on the same screen. It’s about optimization for all your processes. I’m genuinely excited about that, but what I’m most proud of is the major role our customers played in designing this functionality. This is the first time McKesson used our new staged commercialization process. Customers had to sign off on each stage, saying, “Yes, that’s the right set of priorities,” “Those prototypes look good,” “Those are good quality assurance tests,” or “I liked the alpha version.” We’ve had customer support and involvement all along the way. It’s an exciting launch for us.

CT: What are some of the highlight features in the new workflow product?

McComb: It has biometrics and single-user sign-on, which eliminates the need to reauthenticate users as they move from one application to another. From a technical standpoint it uses the latest Dell server that has a tremendous amount of memory for pill and script images. When integrated with Pharmaserv, it has centralized reporting, so you can now mix and match all the reporting that you get in your pharmacy management system with what you get from workflow. In the past, Pharmaserv and P2000 were like distant cousins who spoke to each other by mail once in a while. Now they are two brothers living under the same roof. It’s a much better suite. It’s worth noting that Pharmacy Navigator can also interface with pharmacy management systems other than Pharmaserv.

We also included two other exciting features that came out of our customer brainstorming session — first, pharmacists told us that they spend a lot of time looking for, say, one of five prescriptions for a customer. And it’s always one little odd thing that keeps it hidden; maybe it’s hung up in IVR or in adjudication, or maybe it’s done, but in the refrigerator. So we created a new module called virtual will-call that allows each store to define its own storage locations. Call them bagged, cabinet, refrigerator, delivery — call them whatever you want. You scan a finished prescription and associate it with one of these predefined virtual will-call locations. When Mr. Smith comes to the front counter, you pull up the information in the Rx Tracker module and say, “I see three prescriptions for you in will-call, one in the fridge, and one that’s still waiting for authorization from your physician.” That’s a much more intelligent and efficient conversation than giving him three scripts and then having him go home and call you asking where the fourth and fifth are. In that case, maybe you find the one in the fridge quickly, but then have to call him back after tracking down the fifth, which was waiting for authorization. You add the time that it takes to play detective and multiply that by maybe 20 times a day, and that’s a significant drain on productivity.

CT: There’s been a strong emphasis at this conference on McKesson’s efforts to support medication therapy management [MTM] and adherence. What are your thoughts?

McComb: We all know that differentiation around clinical care is good. There seems to be good momentum across the industry toward MTM. It’s a great opportunity for retail pharmacists because they know their patients, they understand their needs, they are clinical experts, they have a good knowledge base, and they are among the most trusted professionals in the United States. It’s a great opportunity — if they have the time to do it. But think again about what most pharmacists are doing on an average day. They’re getting in early and doing the scripts that came in overnight, or dealing with staffing issues and whatever else is going on. They’re working hard all day, maybe taking lunch and maybe not. At the end of the day, are they going to do pricing or any number of other things? There’s not a whole lot of bandwidth to enable MTM today from an operations standpoint — never mind marketing the service to physicians or doing advertising.

CT: So what role do you see MPS playing?

McComb: From a systems standpoint, we have to find our customers the time and the serenity to do counseling services, be it 5, 20, or 45 minutes. If Mrs. Smith is coming in at 2:30 and she’s a counseling candidate, your system needs to identify her eligibility and then adjust your workflow around that possible appointment. Candidates may come in at various times and, as the pharmacist, you can’t drop everything else. The workflow impact is going to be significant when MTM really gets going — which may be two or three years away — because the time in the day is not there right now. It’s going to be interesting. You are going to have to be able to fill, say, 25% of your scripts that come in overnight before your doors open. This bodes well for pharmacy systems with workflow and workload balancing, and for technology automation, central fill, and after-hours pickup.

CT: It sounds as if technology is going to continue to have a central role in the pharmacy. Thanks for taking the time to share your thoughts with us, Stanton.